Objective: We aimed to assess the efficacy of three different labor induction methods for non-viable third-trimester fetuses.
Methods: This retrospective cohort study included women who had an intra-uterine fetal death or termination of pregnancy at or after 28 weeks of gestation and underwent labor induction by either transcervical foley catheter and concomitant oxytocin infusion or regular doses of vaginal Prostin© or Propess©.The primary outcome was induction to the delivery interval. Secondary outcomes included the rate of women who delivered within 24 h, time spent in the delivery room, failed induction, adverse outcomes and reported occurrence of moderate to severe pain.
Results: Between January 2017 to June 2020, 107 women met the inclusion criteria. 25 women underwent induction of labor using transcervical foley catheter, 44 using Propess©, and 58 by Prostin©. The three groups were found to be demographically similar. The rate of women who delivered within 24 h was higher in the transcervical foley catheter group compared to the Propess© and Prostin© groups (72% vs 25% vs 29.3%, p < .001 respectively). Time to delivery was shorter among the transcervical foley catheter group compared to the Propess© and Prostin© groups (16.97 h vs 39.4 vs 39.3, p < .001 respectively). When comparing the Foley catheter group to both Propess© and Prostin©, moderate to severe pain was significantly more commonly reported in the prostaglandins groups (36.0% vs 50.0% vs 65.62%, p = .04). No difference was found in adverse outcomes, defined as intrapartum fever, post-partum hemorrhage and retained placenta.
Conclusion: Cervical foley catheter with concomitant oxytocin infusion is the most effective method for induction of labor in third trimester non-viable in fetus compared to PGE2.
Keywords: Induction of labor; intra-uterine fetal demise; non-viable fetus; oxytocin; prostaglandin E2; termination of pregnancy; third-trimester; transcervical foley catheter.